Pakistan’s Prime Minister Nawaz Sharif declared a state of emergency on Tuesday as temperatures rose to over 110 degrees F. (43 degrees C.). The government of Sindh Province, which includes Karachi, later declared a public holiday to encourage people to stay indoors out of the sun, according to the Pakistani newspaper Dawn.

Overwhelmed hospitals are struggling to treat a surge of casualties, and morgues are filling to capacity. Chronic shortages of water and electricity in Karachi, Pakistan’s largest city, have exacerbated the crisis.

To make matters worse, the heat wave has coincided with the start of the Islamic fasting month of Ramadan, during which millions of devout Muslims abstain from food and drink from sunrise to sunset. For most people, that means no hydration for about 15 hours. But some senior Islamic clerics have urged those who might be at greatest risk from the heat not to fast, to give them respite from the brutal heat.

"If an expert doctor says that your life is threatened due to the heat, or some condition you may have is going to get worse because of fasting, then you can forgo the daily fast," Mufti Mohammad Naeem, head of Karachi's biggest madrassa, or Islamic school, told NBC News.

The majority of the deaths in Karachi have been among the poor and day laborers who work outdoors. Many have taken the streets in protest over the government’s slow response to the crisis. As the BBC’s Shabzeb Jillani reports:

The provincial PPP government appeared aloof and unresponsive. The federal government of Prime Minister Nawaz Sharif woke up to the tragic deaths on the third day.

While politicians blamed each other for not doing enough, the army – always keen to seize opportunities to demonstrate its soft power – sprang into action to set up "heat stroke relief camps".

Many in Karachi feel that had the authorities moved proactively many lives could have been saved.

The city’s residents are eagerly awaiting the pre-monsoon rains that are expected to come later this week. Meanwhile, temperatures appear to finally be dropping. They’re forecast to peak at 97 degrees F. (36 degrees C.) on Wednesday, as a relatively cool sea breeze started blowing across the city Tuesday evening.

But as Ms. Jillani points out, the improved weather won't change the chronic underlying problems this ever-growing city faces: a dysfunctional infrastructure and poor governance.

The New York Times reports that years of mismanagement of Pakistan’s national grid have led to the electricity shortages. Prime Minister Sharif promised to reduce the energy crisis when he was elected into office two years ago, but so far little has changed amid widespread finger pointing. On Wednesday, political parties running Sindh Province and the federal government blamed each other for the disaster while debating the issue in parliament.